Although communicable diseases still represent the major disease burden in Africa, clinical data suggest that cancer incidence is increasing rapidly in Africa and at a rate that is faster than that in the developed world. There is also evidence tha Western cancers, including cancers of the breast, prostate, colon, and lung, are becoming very common in many African countries. However, just 1% of the continent's population is covered by population-based registries (in the US, 28% of the population is covered by NCI's Surveillance, Epidemiology, and End Results Program and 83% from all state registries combined). The lack of population- based cancer surveillance data makes it difficult to quantify the exact burden of cancer in Africa and develop effective strategies for cancer prevention and control. To help address the need for developing population- based registries to provide information to guide cancer prevention and control efforts, the Cancer Prevention Institute of California (CPIC) is partnering with the University of Ghana Medical School (UGMS), Korle Bu Teaching Hospital (KBTH; a UGMS-affiliated hospital), and the African Cancer Registry Network (AFCRN; a partner of the International Agency for Research on Cancer) to develop a demonstration pilot cancer registration project in Accra, the capital city of Ghana. As a first ste towards an Accra population-based cancer registry, we propose to establish a hospital-based cancer registry at KBTH. KBTH is the largest hospital in the Accra metropolitan area and serves about two-thirds of the Accra population (70% coverage is considered population-based by the AFCRN). The cancer registry developed at KBTH is expected to become the Center for Excellence in Cancer Registration in Ghana, and to be a training center for extending cancer registration to other hospitals in Accra to enhance population coverage beyond 70%. This proposed study will establish effective procedures and training for KBTH-wide active case finding for cancer cases diagnosed in 2014-2015, and for active case reporting for cancer cases diagnosed in 2016-2017 (Aim 1). We will also develop procedures to link the cancer registry with KBTH's tumor archives to create a registry-linked tissue bank that can be used for efficient retrieval of pathology materials for future molecular studies (Aim 2). Finally, we will survey othe hospitals in Accra to assess their willingness to contribute cancer data to a population- based cancer registry (Aim 3). We will hold a workshop on cancer registration and provide training to providers on the importance of cancer registration to help increase awareness and interest in cancer registration. Successful completion of our aims will pave the way for a future population-based registry in Accra that will generate high-quality surveillance data to aid the effort of cancr prevention and control in Ghana. The Ghana registry data can be compared with cancer patterns among African Americans to clarify why persons of African descent are disproportionally affected by certain cancers, such as cancers of the prostate and kidney.